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Telemedicine Consultation Form

Celiac Disease - Adult

Please complete the following Clinical History form if you wish to be treated for Celiac Disease.

Please review the Further Details Of Throne’s Stem Cell Treatment For Autoimmunity page at this link prior to submitting your request for Telephone Consultation since it will answer many of your general questions and allow us to focus on your specific questions during that consultation.

Clinical History Form - Celiac Disease - Adult

If you wish to be considered for treatment of Celiac Disease in an adult with Throne’s Stem Cell Educator Therapy, please submit the following information:

Sex

Celiac Disease History

Have You Been Diagnosed With Celiac Disease or Gluten Sensitive Enteropathy?
What Were Your Symptoms When First Diagnosed With Celiac Disease? Check all that apply.
Did you have a small bowel biopsy at the time of diagnosis? If so, how was it classified?
What Are Your Current Symptoms of Celiac Disease?
Are you currently on a gluten-free diet?
Is There A Family History Of Celiac Disease?
Do You Have Any Of These Other Autoimmune Disorders? Check All That Apply.

If You Had Recent Blood Test Results, Please Enter Them Below

DISCLAIMER: Throne Biotechnologies Stem Cell Educator Therapy is experimental and is not yet approved by the U.S. Food and Drug Administration for the treatment of Type 1 Diabetes.

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